An 82-year-old woman with a history of adenoid cystic carcinoma of the left lower lung, who had undergone surgery and radiotherapy in 1998, presented to our emergency department complaining of abdominal fullness for 1 day. Physical examination revealed tympanicity on percussion and tenderness over the lower abdomen. Laboratory evaluation revealed white blood cell counts (WBCs) 22 500 per cubic mm with 91.6% segmented neutrophils, haemoglobin 11.3 g/dl, blood urea nitrogen 15 mg/dl, creatinine 0.8 mg/dl, blood sugar 156 mg/dl, lactate 75.3 mg/dl (normal <12 mg/dl), and C reactive protein 11.7 mg/dl (normal <0.4 …